Clinicians go through years of education to gain medical knowledge. But the hard learning starts long after they receive their last degrees or graduate from residency. Clinicians go on to spend the rest of their careers developing clinical reasoning: Learning how to actually apply that knowledge. And advanced skill, clinical reasoning develops from experience and clinical context. In many ways, clinical reasoning and not necessarily knowledge separates the novice from the master clinician.

Clinical reasoning in important in pediatric emergency medicine because clinicians face time-sensitive, diverse clinical problems that may not have clear evidence-based answers. In these grey cases, clinical reasoning is an important tool for providing high quality emergency care.

Despite the importance of clinical reasoning, there are few formalized tools to develop it. Textbooks, online resources, CME focus on gaining more medical knowledge and less on the cases where the knowledge may not apply directly or needs to be synthesized. The tools of clinical reasoning training are the patients, experiences, and faculty. Trainees develop clinical reasoning by connecting with more experienced clinicians, “picking your brain” about a case. Even experienced providers continue developing clinical reasoning. For example, when I ask colleagues how I would handle a tough case, I’m working on my clinical reasoning.

However, these moments of connection are becoming more infrequent in training and emergency medicine. Research has shown that trainees spend only a small fraction of their clinical time directly with their supervising physicians. Emergency doctors do shift work, often working in isolation from other clinicians and limiting their clinical reasoning connections.

I wanted to use technology to increase opportunities for clinical reasoning connections. I partnered with a local company called DocMatter to pilot a digital forum for clinicians to share their own challenging cases in pediatric emergency medicine. Called “Pediatric foreEM Bay Area,” the case series focuses on clinical reasoning in pediatric emergency medicine through peer learning. The clinical reasoning connections happen asynchronously over the period of one to two weeks, followed by a summary and case outcome.

DocMatter is a San Francisco-based company that facilitates private discussion groups among physicians of many specialties but has not had one focused on the clinical reasoning in emergency medicine. DocMatter has robust web-based and mobile applications, email notifications, image capabilities, and the ability track some basic user behaviors such as visits. The content is password protected and available only to users in specific groups—which was essential to encourage open discussion of limits in clinical reasoning among peers.

I plan to present some background data on clinical reasoning, some of my prior work on facilitating an asynchronous case discussion in pediatric emergency medicine, and highlight the features of our ongoing project to use Pediatric forEM Bay Area to promote discussions in clinical reasoning, connect providers of pediatric emergency care at Benioff Children’s San Francisco and Oakland and eventually the wider Bay Area.

Slides: https://ucsf.box.com/s/rl875li5hkb99f7zfmjqducmhwxstfz9 (MyAccess login required)